Throughout the past several decades, the American culture has grown obsessed with exercise. The widespread belief is that the only thing better than one hour of exercise, is two, perhaps three.

This perception has only intensified today in our obesity-obsessed culture. Everyone, especially children, are encouraged to “get moving.” Whereas there is absolutely no doubt that regular activity is beneficial on many levels, our love affair with exercise can have negative consequences that few understand. This comes in the form of addiction.

Interestingly, if asked, the vast majority of people would undoubtedly say that addiction is confined to drugs and alcohol; something as unilaterally positive as exercise could not possibly prove harmful.

They would be wrong.

Exercise addiction is referred to as a process addiction; this category of addiction includes such activities as gambling, work, or shopping. When a person engages in a particular behavior, such as prolonged running, opioids and dopamine are released in the brain. The act of running is then associated with feelings of euphoria, well being, and diminished negative emotions such as anxiety, fear, sadness, or loneliness.

As with many addictions, dependence on exercise can start harmlessly enough. For example, imagine a young woman just entering college far from home. It is a time of high stress, both academically and socially; to say nothing of her possible fear of weight gain. She starts running fairly long distances. Not only does she achieve the runners “high” due to the chemicals released in her brain, but the more she runs, the less she thinks, the less she feels. She ultimately becomes dependent on the activity, chasing the euphoria, not unlike a person addicted to alcohol or drugs.

Possibly the worst aspect of exercise addiction is its benign nature. If an individual is always intoxicated or another person has an arm riddled with track marks, then the addiction is obvious; friends and family might intercede. But a person rigorously training for a marathon or spending hours every day in a gym rarely raises an eyebrow. Any exercise, even when extreme, is nearly always seen as healthy, even laudable; therefore, this person only receives validation and reinforcement.

The prevalence of exercise addiction in the general population is about 3%. It comes as no surprise that 39 to 48% of people suffering from eating disorders also suffer from exercise addiction. Those who have experienced trauma are also candidates for this disorder. Not only does exercise offer the “high,” which is positive, but it allows the person an opportunity to escape painful thoughts and emotions connected to trauma. Excessive exercise dulls the mind. To a severely traumatized person, numbness is considered an optimal state.

The Importance of Mindfulness

Like any addiction, an addiction to exercise may be difficult to break; but it can be done. Embracing mindfulness skills can be highly beneficial. Mindfulness is defined as learning to control your mind so it does not control you.

In a process addiction, thoughts and urges become ritualistic and habitual over time. Mindfulness requires an individual to notice the thought then to consider responding to that thought in an entirely new way.

Imagine a woman who has always run 5 miles the day after having a dessert; she must do it to “pay” for the calorie intake. Therefore, if she orders chocolate cake on a Tuesday night, on Wednesday morning, she will have the thought, “I must run 5 miles today.” Being mindful, she can pause and recognize that this as merely a knee-jerk thought instead of an imperative command. Essentially, she discovers she has choice.

Application of mindfulness with exercise is about choosing what is healthy for our body over what our mind dictates; it means listening to our body’s needs and limitations.

Compulsive exercise is a way of escaping the experience of emotions associated with the present or past life events. Conversely, mindful exercise allows people to focus on being in the present and to engage in exercise with a healthy motive.

Exercise addiction is serious; it can result in severe medical and physical consequences, broken relationships, disability, and even premature death. Therefore, if you or someone you know is caught in this addiction, please seek help. In time, reasonable, healthy, and beneficial exercise can be reintroduced as part of a balanced life.

Identifying Exercise Addiction

There are ways to identify exercise addition if you are unsure if you or someone you know is suffering. In order for anything to be given the addiction label, certain criteria must be met. Exercise addiction tends to meet all the standards required by the Diagnostic and Statistical Manual of Mental Disorders, which is the “go-to” reference source for those in the behavioral health field. These criteria include:

• Tolerance: The amount of exercise must be increased to achieve the desired effect.• Withdrawal: Negative effects such as anxiety, irritability, restlessness, and sleep problems ensue when exercise is curtailed.• Lack of Control: Attempts to reduce the level of exercise fail.• Intension: The person is unable to adhere to a normal exercise routine.• Time: An inordinate amount of time is spent preparing for, engaging in, and recovering from exercise.• Reduction in Other Activities: Social, occupational, and/or recreational activities are reduced.•Continuance: Exercise continues despite negative physical, psychological, and/or interpersonal relationship consequences.

If you recognize the signs of an eating disorder in a student, a friend, or your child, how you respond and intervene is crucial. Once you become aware of the issue, you have a responsibility to address it. Many aren’t sure what that next step is and are left asking, “Now what?” Well, I have answers.

The first step is to meet with the individual to discuss your concerns. When you meet, the individual’s parents should be present as well as another person who you identify as being invested in this individual’s well-being and who will provide needed encouragement and support. This could be a coach, nurse, teacher, counselor, principal, or a close friend.

During this meeting, it’s important to follow these three basic steps:

1) Empathize and connect.2) Educate.3) Motivate.

Empathize by showing your concern, and connect by disclosing specific behaviors that you and others have observed, e.g. “I am concerned about you and have noticed you are eating alone at lunch every day.” Educate the individual by sharing with them that eating disorders are serious and complex illnesses that affect their body, thoughts and emotions, and personal relationships. Inform the individual know that eating disorders require professional attention and that the sooner they get help, the better their prognosis. Most importantly, make sure the individual knows that there is help and that they can get better. The next step is devising a plan of action. Motivate the individual by involving them in the creation of this plan. Let their voice be heard, but be sure you are firm about some important next steps, including assessment and treatment.

When confronted about their behaviors, it’s typical for an individual to respond by minimizing or totally denying those behaviors. They may express shame or ambivalence about giving up the behaviors. Anger and fear are also very common responses at this stage. When you shed light on the behaviors you’ve observed, the individuals’ family members and friends may also display denial, shame, guilt, fear, and anxiety. Anticipate these responses, but don’t let them prevent you from intervening when you recognize the signs.

To respond to the increasing prevalence of eating disorders among adolescents and the need for interventions initiated at the school level, Kimberli McCallum, MD and members of the Missouri Eating Disorders Association (MOEDA) Board of Directors have developed a much-needed course for nurses, social workers, counselors, psychologists, coaches, etc. that provides education on identifying and appropriately intervening with students that show signs that they may have an eating disorder. If you are interested in bringing this course, entitled Busting Eating Disorder Myths: How to Recognize and Help At-Risk Students, to your school, please e-mail Dr. Brewer at kbrewer@mccallumplace.com.​By Kathryn Brewer, PhD, LCPC, CCTP, Clinical Director McCallum Place Kansas CityReference: McCallum, K. & MOEDA. (2015). Busting Eating Disorder Myths: How to Recognize and Help At-Risk Students School Curriculum.

But I’m sure you already knew that. Perhaps no one told you; rather, you’ve noticed pink everywhere. When October hits, suddenly we see pink everywhere we turn – from NFL players’ pink socks to pink plastic bags at the grocery store to pink-tinted water flowing through fountains throughout the community.

Efforts to raise awareness about breast cancer date back to the early 1900’s, but the disease did not receive widespread attention until the mid-70’s when President Gerald Ford’s wife, Betty Ford, came forward about her diagnosis and subsequent mastectomy. In the 1980’s, there were a number of grassroots initiatives advocating for early screening. The 1990’s marked the birth of a true, national movement to raise awareness of breast cancer and to influence public policy related to the disease – a push for the implementation of preventative screening measures nationwide and demand for increased funding for breast cancer research. Since that time, outreach efforts surrounding National Breast Cancer Awareness Month have climbed, which has played a significant role in early detection and diagnosis of the disease as well as available funds for research and community support for those affected by the disease. (1) Routine screening is now commonplace, and with the support of research dollars, treatments that yield better prognoses are being developed all the time.

The degree of governmental and community-based support surrounding this disease is incredible, and for good reason.

In 2012, there were an estimated 2,975,314 women living with breast cancer in the United States. (2)

About 1 in 8 women (about 12.3%) will develop breast cancer in her lifetime. (2)

Those statistics are staggering.

But did you know that up to 30,000,000 individuals across all ages and genders are currently suffering from an eating disorder in the United States? (3)

Did you know that eating disorders have the highest mortality rate of any mental illness? (3)

Look at those bold numbers again. Do these numbers surprise you? The number of women affected by breast cancer is grossly overshadowed by the number of individuals affected by eating disorders in our country. Yet only 1 in 10 individuals suffering from an eating disorder seek treatment, (3) research funding for eating disorders falls far below research dollars dedicated to breast cancer – a disappointing $0.93 per affected individual versus $2,596.00 per individual diagnosed with breast cancer (4,5) – and the outreach and prevention efforts surrounding eating disorders are miniscule compared to those linked to breast cancer. National Eating Disorder Awareness Week occurs at the end of February and it is just that – a week.

As a strong advocate for eating disorder outreach and prevention, on one hand, I find myself feeling envious of the governmental backing and widespread community engagement that the breast cancer awareness movement has amassed in only a few short decades and the unmistakable, national support and solidarity that we see every October during National Breast Cancer Awareness Month. On the other hand, however, I’m thankful for our government and health care system’s focus on women’s health initiatives and for the advancement of breast cancer treatments and improvements in this disease’s prognosis. I’m relieved that amidst heated presidential debates and surges of violence across the nation, we can all still come together and unite in support of an important cause. I’m awestruck by the incredible strides of what started as a grassroots effort to increase awareness of a disease that had not received much attention. I’m inspired by how a small movement exploded into one of the most recognized, longest running outreach campaigns to date. And I’m determined to be a part of seeing that such widespread awareness of and advocacy surrounding the prevention and treatment of eating disorders happens in my lifetime.